Sex-Focused Evaluation of Income and Education and the Risk of Atherosclerotic Cardiovascular Diseases Within a Universal Healthcare Context.

BACKGROUND: Although education and income are established determinants of atherosclerotic cardiovascular disease (ASCVD), whether sex differences in ASCVD risk are associated with these factors within a universal public healthcare system is unclear. We examined the independent associations of income and educational attainment with incident ASCVD and their potential variations by sex in Quebec, Canada. METHODS: CARTaGENE is an ongoing prospective cohort study. We completed Cox models to estimate hazard ratios (HRs) for incident ASCVD, stratified by annual household income and educational attainment, among female and male participants without prior ASCVD. The primary endpoint was time to first ASCVD event. RESULTS: There were 17,626 participants with a mean age of 54 ± 8 years (52% female), followed for a median of 6.6 years (2009-2016). Females with the lowest level of education, without collegiate education, had a 61% increase in the hazard of incident ASCVD compared to females with the highest level of education, with university studies (hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.15, 2.26). Compared to those with an annual household income of ≥ $CAD100,000, males with an annual household income of < $CAD50,000 had a 61% increase in the hazard of incident ASCVD (HR:1.61; 95% CI: 1.23, 2.11). CONCLUSIONS: Within a public healthcare system and with relatively affordable medication coverage, we still observed inequalities in ASCVD risk associated with educational attainment and household income. Future research is needed to confirm the potential sex differences in the impacts of educational attainment and income on the risk of ASCVD.